Reflections on Architectural Design: (and the Design of Healthcare Facilities)

In the organization HOSMAC (India) Private Limited I head the architectural design section and what follows are some of my reflections on design in general and the architectural design of healthcare facilities in particular.

Design as a professional activity separated from the making of things is a relatively recent phenomenon, and the trying to understand how designers’ design is a field still in its infancy. In the early years of serious design research it was fashionable to see design as an entirely generic and field-independent activity. Thus a respected worker in the field, Sydney Gregory, could confidently assert that ‘the process of design is the same whether it deals with the design of a new oil refinery, the construction of a cathedral or the writing of Dante’s Divine Comedy’. I am not convinced of this view and rather doubt that Dante would be either! It would be farfetched to compare the mindset and skills required for the design of a healthcare facility in 2011 to those required for the penning of poetry.

Architectural design is generally recognized as presenting a ‘wicked’ problem. By this is meant that such problems defy complete description and lack the clarity of formulation found in scientific problems. They are the sort of problems where the information you need to understand them rather depends on your ideas for solving them. This sort of design is a ‘knowledge-rich’ as opposed to ‘knowledge-lean’ activity. In other words, architectural design requires us to have considerable amounts of knowledge beyond that stated in the problem description. Healthcare design demands sensitivity to as diverse concerns as addressing the anxiety of a cancer patient undergoing treatment to the engineering requirements of the radiation therapy unit in which he or she is being treated. Above all one has to realize that this sort of design involving addressing such varied fields of knowledge and empathy is a process in which there will be no one recognizably correct or even optimal answer.

Early writers on the design process tended to see it as a sequence of cognitive operations conducted entirely within one brain. Such models have an almost unassailable logic and appear quite convincing to those not personally involved in the act of designing. However, while the ‘methodologists’ gathered at conferences to discuss the finer detail of such ideas, designers were quietly ignoring them and getting on with the business of design.

Today it is easy to see why these sequential models of design were doomed to failure. They began from several false premises two of which we need concern ourselves with here. These concern fallacies about the beginning and end of design: first, that design problems are, or indeed, can be stated clearly, and secondly that there are solutions, which can be considered in some way optimal. As mentioned before, today we recognize architectural design problems belonging to a type known as ‘wicked’. They are often vague expressions about a change of some kind, which is needed or desired rather than a clear statement about a totally defined goal. They should therefore most definitely not be considered to be like crosswords or other popular types of puzzle. These are characterized by a totally defined objective and usually have a single correct solution, which can often be recognized as such when it is found. Those who consider design to be merely problem solving do the field a disservice. A large part of the business of designing involves finding problems, understanding and clarifying objectives and attempting to balance criteria for success.

We have now recognized that designers often come to better understand their problems through their attempts to solve them.

Most designers are at their best when designing, rather than writing about the process they follow. Of course, we must sell our services in the marketplace and so we may not always describe our processes honestly! My many years of design experience also suggest that when I like a solution, I can be amazingly creative in imagining the ‘logical’ processes that led to that solution. Other designers too can be quite capable of denying to both themselves and others the obvious importance of issues that they have chosen either to ignore completely or to relegate to minor consideration. Depending on who is ‘driving’ the project, a doctor, an investor, a Vice-President (Projects) or a philanthropist, the frame of reference through which the decision-making process is viewed can vary greatly. The designer then has to ‘wear the hats’ of those users of the facility who are getting neglected as to their needs as well as he can, champion their interest through the design process. Further to this, architects are expected to have a social conscience, to ensure that the buildings they design are good neighbors and eco-friendly. Design has to address a multitude of issues; the designer has to put his values on the line.

It is a reasonable assumption that clients choose architects to some extent because they like earlier designs they have seen, or, as in the field of healthcare design, because of special knowledge of the particular features of the building type. Some clients have a very clear vision of how they want the final design to be, while others may have almost no idea. Some clients are particularly concerned about some feature and care little about others. The relationship between client and designer therefore is not like an examiner setting students a question but rather more like someone needing help in a situation where many courses of action are possible.

At its best, the interaction between client and designer can be a highly interactive and creative one.

Design is undoubtedly an artistic business, but it is dangerous to confuse it with art. Most designers see themselves as artistic but not necessarily as artists. Design usually involves making something that must work in some way as well as expressing some values or ideas. Inevitably, the end product of contemporary architectural design often demands that a great deal of technology be employed. This is especially the case in the design of today’s healthcare facilities. The extent to which the problems posed by technology influence the designer’s thoughts is a central issue in understanding the design process. Within the same healthcare facility, the architect may switch mental gears (tracks?) while designing the inpatient areas as contrasted with an Operation Theater Suite. Nowadays there is a proliferation in architectural theory and also a considerable variation in the way architects regard the role of technology in design. In healthcare facility design in the new millennium, though, architects necessarily need to understand the technological requirements of the building. The new frontiers in the delivery of healthcare through hospitals are divergent, one concerned with alleviating mental distress in the form of addressing the anxiety felt by patients and their family in highly stressful situations, and the other concerned with the frontier of designing for the engineering needs of contemporary medical technology.

There are of course many other questions about the nature of the design process that could be posed, and the reader will no doubt have his own. The few central issues I have raised are an attempt to stimulate the mind.

It becomes necessary to bring some of the issues about design raised here into sharper focus by dealing with them directly and comparing and contrasting various approaches to them. While there may be as many approaches to architectural design as there are architects, I suspect that in the healthcare design fraternity there may be more consensus on the general way forward. Being a fragment of the whole, there is likely to be more uniformity within.

For now I leave you with this thought: The great philosopher Ludwig Wittgenstein is reported to have said ‘you think philosophy is difficult enough, but I tell you it is nothing to the difficulty of being a good architect’.